A 72-year-old male is diagnosed with paradoxical embolus after he presented with concurrent deep vein thrombosis, stroke, and multiple arterial emboli in the presence of a patent foramen ovale (PFO). Paradoxical embolus requires the passage of a thrombus from the venous into the arterial circulation through a right-to-left shunt leading to systemic embolism. But, despite the high incidence of PFO (27.3% across all age groups by autopsy), paradoxical embolism (PDE) is uncommon, representing &lt;2% of all arterial emboli. We present a case report where a thrombus has been directly observed passing through the PFO during an echocardiogram study; thus, clearly delineating the true cause of multiple thromboemboli and stoke in our patient. Subsequent Transesophageal Echocardiography (TEE) also interestingly showed the thrombus in transit in the aorta and pulmonary artery.

Mentions:
Also, multiple mobile emboli were seen in the aortic arch (Fig. 3), and large emboli in transit were seen in the pulmonary artery as well (Fig. 4). Lower extremity arterial and venous Doppler demonstrated bilateral deep vein thrombosis (DVT) with acute left femoral artery occlusion as well. Patient was critically ill, and despite supportive care, he succumbed to the large thrombus burden affecting multiple organ systems and causing pulmonary embolism, major stroke, and acute limb ischemia.

Mentions:
Also, multiple mobile emboli were seen in the aortic arch (Fig. 3), and large emboli in transit were seen in the pulmonary artery as well (Fig. 4). Lower extremity arterial and venous Doppler demonstrated bilateral deep vein thrombosis (DVT) with acute left femoral artery occlusion as well. Patient was critically ill, and despite supportive care, he succumbed to the large thrombus burden affecting multiple organ systems and causing pulmonary embolism, major stroke, and acute limb ischemia.

A 72-year-old male is diagnosed with paradoxical embolus after he presented with concurrent deep vein thrombosis, stroke, and multiple arterial emboli in the presence of a patent foramen ovale (PFO). Paradoxical embolus requires the passage of a thrombus from the venous into the arterial circulation through a right-to-left shunt leading to systemic embolism. But, despite the high incidence of PFO (27.3% across all age groups by autopsy), paradoxical embolism (PDE) is uncommon, representing &lt;2% of all arterial emboli. We present a case report where a thrombus has been directly observed passing through the PFO during an echocardiogram study; thus, clearly delineating the true cause of multiple thromboemboli and stoke in our patient. Subsequent Transesophageal Echocardiography (TEE) also interestingly showed the thrombus in transit in the aorta and pulmonary artery.